Provider Demographics
NPI:1912381062
Name:SUMMIT PHYSICIAN SERVICES
Entity Type:Organization
Organization Name:SUMMIT PHYSICIAN SERVICES
Other - Org Name:WELLSPAN INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VP OF PHYSICIAN SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:LISSA
Authorized Official - Middle Name:N
Authorized Official - Last Name:HINCKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-267-4839
Mailing Address - Street 1:785 5TH AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-217-4218
Practice Address - Street 1:601 E MAIN ST
Practice Address - Street 2:LEVEL 3
Practice Address - City:WAYNESBORO
Practice Address - State:PA
Practice Address - Zip Code:17268-2332
Practice Address - Country:US
Practice Address - Phone:717-765-5060
Practice Address - Fax:717-765-5072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-17
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007307260075Medicaid